The Director of Medical Economics provides leadership in managing overall medical costs, regional medical cost action plans, and designs metrics for business partners that are accountable for implementation of action plans. Responsible for building expertise in provider contracting by leading the design, development, and distribution of database tools and applications to efficiently measure monitor, and/or forecast medical cost structure. Develops and presents actionable recommendations for utilization and unit cost management to business partners based on analysis. Partners with actuarial, underwriting, network, clinical and operations leaders to establish implementation strategy of action items.
Utilizes data and analytic information available to drive decisions, and evaluates impact, effectiveness, performance, and costs
Provides leadership with quantitative analysis of healthcare cost and utilization data, identifying and implementing the appropriate analytic approaches and methodologies
Partners with line of business leaders to develop and design medical economics analysis and outcomes reporting to be used for internal and external purposes
Supports month end analysis, budget and forecast development, and medical expense projections
Supports the development of medical expense management initiatives inclusive of cost saving projections and offsets in partnership with internal and external stakeholders
Collects and refines appropriate data for analysis, provides summations, observations, and insights to address utilization trends and presents findings to management and other stakeholders (internal and external)
Participates in strategic discussions regarding medical cost, utilization, contracting and care collaboration, and network programs
Partners with leadership to develop analysis of provider cost and quality performance, identify opportunities for improvement, and propose changes to the reimbursement models, risk arrangements, etc.
Leads medical expense work groups consisting of an interdisciplinary team of individuals from across the organization
Actively measures and presents the effectiveness and return on investment of clinical programs
Coordinates, manages, and tracks performance standards and reporting by developing effective tools that measure progress and the achievement of milestones
Provides very complex programing and analytical support for medical cost trend analysis and strategic planning
Creates population-based medical cost analyses from concept to completion
Analyzes historical provider trends and experience to support the Company's strategic goals
Interprets and communicates changes to regulatory requirements
Trains team members on analytical tools and techniques
Bachelor’s degree in business, health administration, health policy, finance or a related field required; Master’s degree preferred
5+ years of experience in the areas of managed care analytics and risk management, Medicare Advantage programs, Medicare payment practices and policies, managed care finance, network contracting, and clinical program cost-effectiveness analytics required
Experience developing tools designed to monitor and analyze cost and utilization trends
Experience creating, reconciling, summarizing, and analyzing financial and/or statistical data including work with pricing and other key financial departments required
Experience working with MS Suite products, including Word, PowerPoint, and Advanced Excel skills
Leadership experience is preferred
Solid knowledge of standard medical coding preferred
In compliance with MPHC’s Department of Defense government contract, any/all persons hired for this position will need to verify their US citizenship and complete the required employment eligibility verification upon hire. ?
Employer will assist with relocation costs.
Additional Salary Information: Eligibility for up to 15% Annual Achievement Award
Internal Number: 1-2021
About Martin's Point Health Care
Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day. Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015.